Provider Demographics
NPI:1659574176
Name:LARRAGOITE, MARION LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:LAWRENCE
Last Name:LARRAGOITE
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:2904 RODEO PARK DR E
Mailing Address - Street 2:SUITE 400-B
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6305
Mailing Address - Country:US
Mailing Address - Phone:505-983-3484
Mailing Address - Fax:505-424-0338
Practice Address - Street 1:2904 RODEO PARK DR E
Practice Address - Street 2:SUITE 400-B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6305
Practice Address - Country:US
Practice Address - Phone:505-983-3484
Practice Address - Fax:505-424-0338
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMNM17241223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics